Transverse False Tendons in the Left Ventricular Cavity Are Associated with Early Repolarization

Abstract

BackgroundLeft ventricular false tendons (LVFTs) are related to precordial murmurs, ventricular arrhythmias and some repolarization abnormalities. Early repolarization (ER) is a specific type of repolarization abnormality.ObjectiveThe aim of the present study was to investigate the relationship between LVFTs and ER.MethodsThis study retrospectively included 99 consecutive healthy subjects and 33 patients with ER. Early repolarization was defined as an elevation of the QRS-ST junction of >0.1 mV from baseline in at least 2 inferior or lateral leads, manifested as QRS slurring or notching. Each participant was examined using echocardiography with second harmonic imaging, and the attachments of the LVFTs were recorded.ResultsA total of 93 LVFTs were present in 82 (83%) of the 99 healthy subjects. Of these 93 LVFTs, the majority (79/93, or 84.9%) were longitudinal-type LVFTs, which originated from the basal interventricular septum (IVS) and progressed toward the apical segment of the left ventricular free wall. There were significant differences in the positioning of the LVFTs between the ER patients and control (P < 0.0001). LVFTs between mid-IVS to the middle of the LV free wall were found more common in patients with ER compared with control subjects (47.5% vs. 6.5%, P < 0.0001). In the ER group, LVFTs between the basal IVS to the apical segment of LV free wall were only identified in 21% of the LVFTs, compared to a value of 84.9% for the control group (P < 0.0001). The distribution of LVFT trends in the ER group was also significantly different from that in the control group (P < 0.05).ConclusionsLVFTs are commonly visualized using echocardiography. An LVFT from the basal IVS to the apical segment of the left ventricular free wall may be a normal anatomical structure in the left ventricular cavity. On the contrary, transverse false tendons in the left ventricular cavity may be associated with ER.

Left ventricular false tendons

“…This phenomenon is also seen in a study by Hall et al, where 15 out of 100 matched "controls" appeared to have an LVFT, supporting a more frequent prevalence of LVFTs in the general population [6]. An autopsy study by Luetmer et al described presence of LVFTs in 55% of hearts [7] and LVFTs were present in 78% and 83% of hospital-referred children and healthy subjects respectively [4]. The reported prevalence of LVFTs can also be subject to selection bias, as presence of LVFTs have been associated with innocent precordial murmurs.…”

“…Presence of LVFTs may be associated with abnormal ventricular repolarisation in young healthy subjects in competitive sports [4,[10][11][12]. Inverted symmetrical, sometimes biphasic, T waves can be seen (especially in V1-V3) which regress with increase in heart rate during exercise testing.…”

Early repolarization and echocardiography: Some aspects to consider

“…Nakagama et al found a frequent association in patients with type 1 and 2 false tendon and the presence of J waves (Nakagawa et al, 2012). Liu et al, 2015 also found a strong association between ER and the presence of false transverse tendon. On the other hand, the authors use the LA diameter to evaluate the dilatation of this chamber.…”

Condition of the central hemodynamics in children with false tendons in the left cardiac ventricle

“…АРХ были впервые описаны в 1893 году W. A. Turner [5] и представляют собой тонкие образования, расположенные внутри сердца, которые не крепятся к створкам атриовентрикулярных клапанов, а прикрепляются к противоположным свободным стенкам желудочков или между папиллярными мышцами [6,7] и чаще всего они встречаются у мужчин [8]. Они могут обнаруживаться как самостоятельно, так и с другими малыми структурными аномалиями сердца, например -с ПМК [9].…”